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Research Week 2018: 'Doing the right thing matters.’ Shining a light on cancer care disparities

OHSU oncologist studies how race, gender, health insurance status impacts access among vulnerable populations with cancer
Radiation treatment research.  “People who didn’t have private insurance, particularly underrepresented minorities, were less likely to get radiation treatment,” says Woody McClelland III, M.D., who researches disparities in cancer care. “Decreased access to radiation is as big as a determinant of health as it’s ever been.” (Getty Images)
 “People who didn’t have private insurance, particularly underrepresented minorities, were less likely to get radiation treatment,” says Woody McClelland III, M.D., who researches disparities in cancer care. “Decreased access to radiation is as big as a determinant of health as it’s ever been.” (Getty Images)

Woody McClelland is clear about his motivation to practice medicine: “I entered this field to help people. If we wanted to help ourselves, we’d go into Wall Street.”

Woody McClelland III, M.D.
Shearwood “Woody” McClelland III, M.D.

Shearwood “Woody” McClelland III, M.D., is a clinical research assistant in radiation medicine in the OHSU School of Medicine. In addition to assisting patients with cancer at the Tuality/OHSU Cancer Center in Hillsboro, Oregon, McClelland is a prolific researcher whose work has been presented at more than 30 national and international scientific meetings.

His latest study, featured in Advances in Radiation Oncology, one of the American Society for Radiation Oncology’s three flagship journals, analyzes health disparities in cancer care through the lens of four patient populations: African-Americans, Native Americans, Hispanic-Americans and Appalachian-Americans. 

Bringing awareness to health care issues facing these patient populations was important to him, personally, McClelland says.

“It matters to me that people in Portland are cared for, that people in Appalachia are cared for. It matters that African-Americans and Hispanic-Americans are cared for,” he says. “Everyone should be cared for. Doing the right thing matters.”

Born to be a doctor

McClelland was destined for medicine from the start. His parents met while attending medical school, and he was born when they were both fellows at the Columbia University College of Physicians and Surgeons. Following in his family’s footsteps, he decided to pursue medicine and was elected president of the Harvard University Black Men’s Forum. After graduating from medical school at Columbia University, he spent a year with the National Institutes of Health studying patients with epilepsy. While he enjoyed the specialty, he has noticed that radiation oncology has an extensive appeal.  

“It’s not just about the brain or the spine,” he said. “Radiation oncology deals with cancer everywhere in the body. Working in a field that affects so many people really appealed to me.”

McClelland has always had an interest in unearthing disparities in health care and seeks to bring attention to the trends he’s seen occurring across the country: “People who didn’t have private insurance, particularly underrepresented minorities, were less likely to get radiation treatment,” he explains. “Decreased access to radiation is as big as a determinant of health as it’s ever been.”

The research series

The editor for Advances in Radiation Oncology originally asked McClelland to write one article on disparities in health care, but McClelland says he didn’t feel one article could do the topic justice. Instead, he suggested a series of research papers for the journal, each focusing on a different patient population.

The journal published a preamble explaining the impetus for this series: “It is important that we as a medical community never neglect the equally noble task of bridging the barriers that prevent many in North America from receiving radiation therapy, barriers that, in some cases, are as great as those in the poorest nations in the world.”

Each paper in McClelland’s four-part series begins with the same title — “The pervasive crisis of diminishing radiation therapy access for vulnerable populations in the United States” — and addresses four different populations that are most vulnerable to limited radiation therapy access, including: African-American patients, Native American/American Indian patients, Hispanic-American patients. The fourth, and final, paper — “Addressing the Appalachian-American patient population” — is expected to publish this summer.

Results summary

  • Part 1, on the African-American patient population: McClelland’s research found that African-Americans in the United States have diminished access to radiation therapy compared with Caucasian patients, independent of, but often in tandem with, low socioeconomic status. Disparities in access to radiation therapy for African-Americans were most prominently studied in cancers of the: breast, prostate, gynecologic system and hematologic system.
  • Part 2, on the American Indian/Alaska Native patient population: The amount of information regarding radiation therapy access in American Indian/Alaska Native patients is limited, with nearly all peer-reviewed published progress in this area being associated with the Walking Forward program. Over the course of its 15-year existence, the program has resulted in patients presenting with earlier stages of disease and experiencing higher cure rates. Given the similarities with cancer disparities of populations worldwide, McClelland argues the American Indian/Alaska Native experience should be included within the broad issue of a global shortage of cancer care among underserved populations.
  • Part 3, on the Hispanic-American patient population: Hispanic-Americans in the United States have diminished radiation therapy access compared with Caucasian patients, but are less likely to suffer concomitant disparities in mortality than other underrepresented minorities suffering similar disparities (such as African-Americans). Hispanic-Americans born outside of the United States and/or have limited English proficiency may be more likely to suffer substandard RT access.

If patients take away just one message from this research, McClelland hopes it will be this: “If you are a patient with a cancer diagnosis and you’ve never heard of radiation, you need to ask. If your doctor isn’t offering it, you need to ask.”

He says radiation therapy can be forgotten in cancer treatment, and it’s important for patients to know that at multidisciplinary cancer centers such as OHSU, radiation therapists work hand-in-hand with oncologists and surgeons. The goal is to provide patients with treatment options, and a streamlined experience.

McClelland encourages patients to research treatment options, including radiation therapy. He says he worked with the journal to make the research series available online at no cost, with the goal of educating the public.

The legacy of this research

Though the data will change 10 years from now, McClelland says he believes the concept, ideas and spirit behind it will never die.

He says all medical professionals have an obligation to help their patients access the best care for that individual, which for cancer patients should at the very least involve a discussion of radiation therapy as an option. The importance of this research, he believes, is to help challenge the status quo which may be resistant to incorporating radiation therapy as a treatment option: “I think it’s very difficult for establishments to let go of something that has worked for them in the past, even if doing so will benefit substantially more people.”

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